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HomeMy WebLinkAbout040-1303-00-050 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORgATION (ATTACH TO PERMIT) 578932 $ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ZtI Z'710 Permit Holder's Name: City Village X Township Parcel Tax No: C&J Builders Inc., c/o Jeff J. Husb Tro , Town of 040-1303-00-050 CST BM Elev: In BM Elev: BM Description: T Section/Town/Range/Map No: 22.28.19.1785 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ; ~y s CAPACITY STATION BS I FS ELEV. Septic 4 , Benchmark t 505 4tv-5i AZ Dosing L&) ; -C 5 e -r Z 7So Alt. .PM 10 (43 Go 169 -z F r 1 Po 5Z s Bldg. Sewer Holding JC Zf p A . 7y St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet / TANK TO P/L WELL BLDG. ent t it Intake 7~ Z9 ld I ROAD Dt Inlet Septic ~ 9a(, 9 1. 5 41 3 Z 3tj A4 , 5 Dt Bottom IZ.31, 9 Dosing , ~o ~ 4~ 715 ! Header/Man. -7. 162- T-ration - - - Dist. Pipe Holding -7r a dZ Bot. System -7. is gz PUMP/SIPHON INFORMATION Final Grade Manufacturer ~b 3 Demand St Cover Za Model Number e 1 GPM /67-'% 9•S 1~4' ,ate 4 TDH Lift Friction Loss System Head TDH Flt, a~ 5~ r y ale 6 , ~-c_ t b F 1, lam. Forcemain Length Dia. j Dist. to Well / 25 z /aa SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length76 INo.OfTrenc s PIT DIMENSIONS No. Of Pits Inside Dia. LiquDIMENSIONS ~e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER LEACHING Manufacturer: INFORMATION OR \ Typep[System: /V' 3$ g I! 1 N UNIT Model Number: DISTRIBUTION SYSTEM (.Jee. - 1 HeadedManifo~d =Lepn n x Hole Size r ► x Hole Spacing i Jen7 o Air//I~ntake Length (O Dia Z 76 Dia Zs Spacing3 g 3• / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Dh Over x-S eede Sodded , Mulched Trench Edges i- a Yes No L ~am- Ed No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # '5' Z C11'~~f In Pection #2: / / Location: 204 Walnut Hill Way River Falls, WI 54022 (NW 1/4 SE 1/4 22 T28N R19W) Walnut Hill Frarm a The r ute Parcel No: 22.28.19.1785 1.) Alt BM Description = F't k GoJ ¢l`, L T 2.) Bldg sewer length = 2 1 / ~1=5 0 v - amount of cover = Z r r ~ v` 0.0~rC1 ~ Plan revision Required? Yes No Use other side for additional information. SBD-671 0 (R.3/97) Date Insepctoes. S' nature - i Cert. No. ECEIVED. ~`~f ari~T County Safety and Buildings Division fo "i 201 W. Washl *ve , P.0 BOX 7162 Sanitary Permit Number (to be filled in by Co.) 'li M~dlo~I/53707-72 140M Milt P1MV tie, 45 2,F 473Z, 'FFYCtp~;~4' Transaction Number Sanitary Permit Application 4nta In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governme:24 6 ~ 9 10 mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are subct Address (if different than the Department of Safety and Professional Servies. Personal information you provide may be used for sepurposes in accordance with the Privacy Law, s. 15.04(1 (m , Slats. aG Zj 0,J W 1. Application Information - Please Print I for i8 ~ `f Property Owner's Name n f f 2 Parcel # T J e tl L-PS J o 6--X303-Do -0MV Property Owner's Mailing Address 4 Property Location 01 t ~ $ 5~ r4 5 ~C ( ,e'Pr • Govt. Lot F7 0 _ l/ City, State Zip Code~1 Phone Number p,~j S,6 Section a-" of l' , t l , 1,57 t5 0/ / ~.~i^ a7~o`1 1 / 3L T N, R circle on;,), s7f (2 II. Type of Building (check all that apply) Lot # & All or 2 Family Dwelling - Number of Bedrooms n4 Subdivision Name ❑ Public/Commercial -Describe Use- 6k LAJ Fr Ym PIC- ❑ City of ❑ State Owned - Describe Use CSM Number Village of J (.Town of ro k D 14v 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) x A. ANew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B ❑'Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued . / Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that al I C-,6 I D r, ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil M Mound 124 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Require 00 Dispersal Area Propo d (sf) System levation d0 ose H ",~5-taZA, D o0D Z, ,3L L 0.8 0 VI. Tank Info Capacity in Total # of Manufacturer Y , Gallons Gallons Units / U 0 H y New Tanks Existing Tanks U)le 5 c S y 0,/r r 9 U v~ y ai w C7 A, _V &J . is r Holding Tank ),;7S f d 1 pkz rG v-7i _7 Dosing Chamber 0 9_~ 14 t f VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumb s Name (Print) Plu er's Signature MP/MPRS Number Business Phone Number N, c/.~ e ~ 4vzl Plumber's Address (Street, City, State Zip C e) W Na.5 Nor A)V 4 / I ~ ~Z s 6Z VII oun /De artment Use Only Approved ❑ lsap Permit Fee Date Issued Issuin ent Signature 11 Owne en Reason for Den I $ 5 a5 IX. Condi~igi l *nt et r for Disapproval 3\ Q yY , /1 ' & d IIP~.) I", t3eptic tank, etflttt~rtt titter and` , ) It7 lde. dispersal cell must all be se PA;A 6s !maintained as-per management plan provided by plumber. ` ^~JL~ e lr_ 2 Ap s Ckt f~equu emeMa, mttst 6ealt&aft ru!d, dG . JTi1 tG rp st pef appNcabii Ctade / otdl». Y l P_f',µ: d" Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches ' size SBD-6398 (R. 11/11) Plot Plan Page 9' of I Property Owner L ~iA-iizew-.5 Mve. I"=4Qft. Legal Description Ltl- 50 WA" r Iti LL- F4teAk (except where note) r~ = Backhoe pit (hio'ae-),flr, &P T#f6 1VwVq GAF' TjtE 5EVq, 50C- ZZ i 'iZg/l3, R IC[ W, ro w - OF-1-Ke ST CR.011F CDD U-Ajw ~ 1n3 t 8S }~Cle€~ If" wi yn; 1+1U- WAY North ie s- 'fib. 00 ~ ~ t3 _ ~,oi s I'vi L '7 sp~~r" ice-;=-FO Q l oba9 0iY 11 4 ~ 7 Site Location: 0 P A-W'" Y MARY JO HUPPERT Page 2 10/1/2014 , Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. aGerarid'M Swim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm ~PtiyAR~A1Er DIVISION OF INDUSTRY SERVICES o 3824 N CREEKSIDE LA _ D 9 \ HOLMEN WI 54636 3 s k X71 ~ ) l Contact Through Relay P S hftp://dsps.wi.gov/programs/industry-services oA~O 5~~~~ T www.wisconsin.gov ssIONScott Walker, Governor Dave Ross, Secretary October 01, 2014 CUST ID No. 224832 ATTN.• POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/01/2016 SITE: C&J Builders Identification Numbers 204 Walnut Hill Way Transaction ID No. 2462710 Town of Troy Site ID No. 806613 St Croix County Please refer to both identification numbers, NW1/4, SE1/4, S22, T28N, R19W above, in all correspondence with the agency, Lot: 50, Subdivision: Walnut Hill Farm FOR: Description: Four Bedroom Mound System /12% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1505556 Maintenance required; 600 GPD Flow rate; 15 in Soil minimum depth to limiting factor from original grade System(s): EZFlow Mound Component Manual, (R. 7/12); Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. CONDITIO No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, APPRO stats. DEPT OF SAF The following conditions shall be met during construction or installation and prior to occupancy or use: PROFESSIONAL. Reminders: DIVISION OF INDUS • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made ",SEE CORR the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal component shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. MARY JO HUPPERT Page 2 10/1/2014 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1): • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 v'~ v This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 1 I EZflow® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN ' Residential Application INDEX AND TITLE PAGE C Project Name: C & J BUILDERS INC. L~ Owner's Name: (same) Owner's Address: 243 Steelhead Drive River Falls, WI 54022 Legal Description: NW 1/4 of the SE 1/4, Sec. 22, T28N, R19W Township: Trod M County: St. Croix Subdivision Name: Walnut Hill Farm (Tribute) NALLY NA VED Lot Number: 50 Block Number: NA ETY AND ,SERVICES Parcel I.D. Number: 040 -1303 - 00 - 050 TRY SERVICES Plan Transaction No.: NXC tO'~ r® Page 1 Index and title ' ~ENCE ~~,!ic A; Page 2 Data entry • % Page 3 EZflow mound drawings MAP D y ) Page 4 Lateral and dose tank * i HUPPERT • = Page 5 Distribution media D 18 5 Page 6 System maintenance specifications ';RIVET{<.A al.. Page 7 Management and contingency plan P z:7 9 > 'r€I Page 8 Pump curve and specifications Page 9 Plot Plan Designer: Mager Jo_Huppert License Number: 1859-007 Date: 0,9//119//14 Phone Number: 715-426-1775 Signature: y / 1J rv Designed Pursuant to the EZflow Mound Component Manual Ver. August 20, 2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) EZflow Mound Version 3.0 (R. 3/1/12) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information tr or c} r Residential or Commercial Design 400.00 Estimated Wastewater Flow (gpd) 1.50. Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) 12.00 Site Slope 99.75 Installation Contour Line Elevation (ft) 120.00 Contour Length Available (ft) 15.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/fly) Distribution Cell Information 9.00 Cell Width (ft) 3, 4, 5. 6, 7. 8 5 or 10 0n1y 70.00 = Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) e Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation (ft) I J' Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 9.13 ft?/orifice 2.00 Forcemain Diameter (in) 20.00 Forcemain Length (ft) Does the forcemain drain back? Y 94.00 Inside Pump Tank Elevation (ft) Eater Y or N 0.00 Forcemain Filter Loss (ft) 6.50 System Head (ft) x 1.3 3.26 Forcemain Drainback (gal) 7.00 Vertical Lift (ft) 65.39 5x Void Volume (gal) 0.35 Friction Loss (ft) 68.66 Minimum Dose Volume (gal) 13.85 Total Dynamic Head (ft) 28.42 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. o tions choice 0.75 1.25 x x 1.00 1.50 x 1.25 x -__..X 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1250.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) Polylok Filter Manufacturer 20.28 Dose Tank Volume (gain) 525 Filter Model Number Weiser Concrete Manufacturer Project: C & J BUILDERS INC. Page 2 of 9 L01- 4 t Mound Plan View t 1/10 B " " " " " " " ' Observation Pipe K . J.}.}•l• f:f •l:: •T.f.l.l.f l.l.r.: .l.f. :r.l:l.: .l:l.r•r.: •f; l..:° J.d •r.r .°f:'f.~'.',r:f•."tif~f•.tti1'1J'• c A •1".%4•°.ftij•1.':•l°.•ti..'1'°.•°.`,°"L.'°.•..•1.•'°'r•f1'I'~f~~~°1. •fL•••L`• l.J'.:.f....; .1.... r....: :J `~•1.:•t.d.:•1'Llti:LlL:L:Lj'..L:LrL:ti.1•L:L:tijL:L!b:1•'y.b:,;::•:b:L: . '~.•b•b•L•b••.•b•L•L•b.•.• b•°.•L.L•b•L• I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L Mound Component Dimensions ft A 9.00 ft E 33.96 in H 1.00 ft K Elft B 70.00 ft F 12.00 in z 20.30 ft L ft D 21.00 in G 0.50 ft J 7.17 ft W 630.00 (ft2) Dispersal Cell Area 2050.78 (ft2) Basal Area Available 8.57 (gpd/ft) Linear Loading Rate 7.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 103.50 (ft) H .,rrrr;rrrr 2 .rrrrrrrr... G F _ 102.00 (ft) Lateral I Dispersal Cell 101.50 (ft) 6" Invert Elevation Dispersal Cell Elevation 4 99.75 (ft) Contour Elevation 12.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 Topsoil Cap a 0 La. Approved Geotextile Fabric Cover 2 ~rr••rr' Subsoil Cap c 2.0 ft ASTM C33 Sand r ;~;ti , 1r°r• L 1 ~r :ti•L• 4 Tilled Layer ' f•r•f• F °o ~ ~ r 5 f:r:r~ r~r :f: r: 5 r:f:r: 1 ® L.L L L.b L• L•ti•L• -F~ 5 j r•r•} W C ~ .r. r.r•r• r•r•~'•r•r•r• ~'r'r•r•r•r° ti•L•L•b• EZflow Media L•L L•L L• L•L•L•L•L L L•L L•L•L.L f•r•r•r•r •r•r•r•r•r •?•r'r'r.f• d 0.5 ft :f~r~ L ;r r~ L SjLfti•L• A See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: C & J BUILDERS INC. Page 3 of 9 U'T So t End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Ri ht Below Turn-ups YW bell vsiw or vtoaaoutplu p P -Z --')11 st orifice located at Z If x -14 An werwi; odenaw, wah oafts &Vwty spece4 S Foce mein cmnnectim als tee or [rats to marrow !t aay pant. La-ais & lords main of PVC Sdh 40 S Per SPS Table M14.WO66 Orifices point up except every 9th one poirds down for drainage. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.11 ft Lateral Length (P) 69.21 ft Orifices per Lateral 23 Lateral End (Z) 0.79 ft Orifice Density 9.13 fe/orifice Lateral Spacing (S) 3.00 ft Manifold Length 6.00 ft Lateral Flow Rate 9.47 gpm Manifold Diameter 1.25 in System Flow Rate 28.42 gpm Forcemain Velocity 2.90 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical t316.3OOWAC d SPS 4 in. min. Disconnect Tank compo nent is E- - Alternate outlet location Fonemain diameter Weiser Concrete Manufacturer 2 in. Capacity 750.00 Gallons T Volume 20.28 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 21.60 437.98 C B M 2.00 40.56 ~ P♦ ump off elevation (ft) C 3.39 68.66 94.83 D 10,00; 202.80 D Total ~ 36.98 750.00 Dom se tank elevation (ft) Bedding And Backfill As Per Manufacturer 94.00 Alarm Manufacturer SJE Rho_bus _ Alarm Model Number lWi Ta_nk Alert Pump Manufacturer Zoeller _ Y...... Pump Model Number Pump Must Deliver 28.42 gpm at 14.02 ft TDH Note: Switches containing mercury may not be used in this system. Project: C & J BUILDERS INC. Page 4 of 9 L.Crr 5O EVIowe Distribution Cell Media Layout 9.00 Cell Width (ft) 1.50 Sidewail to Lateral (ft) Distribution Cell Cross-section Arrangements 9 ft Wide 64006"q%@ Component Legend ® SR1-7A Bundle - 5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or @XSO SR3-12H in 5 ft or 10 ft lengths O 4" Perforated Distribution Pipe With Pressure Lateral Inside • Turnup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 9.00 Cell Width - A (ft) 70.00 Cell Length - B (ft) 9tD 6@"W Connection Lateral Layout Diagram Force Main ~i 9 ft Wide End - Manifold Project: C & J BUILDERS INC. Page 5 of 9 LDT Mound System Maintenance and Operation Specifications Service Provider's Name Darrell's Septic Service Phone 715-425-1025 POWTS Regulator's Name St. Croix County Zoning Office Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Inspect and clean as necessary at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested eve 3 ears Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the EZtlow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade • • • • • • . Threaded Cleanout 6-8" Diameter Lawn Plug or Ball Valve Sprinkler Valve Box Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral EZtlow Synthetic Media 2.06 Feet Distribution Lateral Lateral Cleanout Project: C & J BUILDERS INC. Page 6 of 9 LbT .50 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [EZflowMound Component Manual 8/20/07, Pressure Distribution Component Manual Ver. 2.0 SBO-10706-P (N. 01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner as to when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Wisconsin Department of Commerce. Pump Tank The dosing (pump) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. If the force main has a weep hole, it should be noted if it is functional during pump operation, and if not, it should be cleaned. *****No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: C & J BUILDERS INC. Page 7 of 9 Lh-r =-D r J r/O D 7/9 r W HEAD CAP i 30 I a zs - °a , 3 5/fl s 20 .0 + + c~. 1 Q a t0 1 4 3/16 2 5 1 1/2-11 112 NPT 0 U.s. Calu)ntS r o 20 40 50 60 70 80 LITERS 0 rxr 160 240 FL PER MINUTE MODEL 98 80 CYCLE Feet Gallons Meters Liter 5 72 1.5 273 to 67 3.1 231 .5 45 4 G 170 20 25 G.7 95 ' Z Loch wan: T3• 'f ' ma5a7 4 3/16 Sa17a2 s~ CONSULT FACTORY FOR SPECIAL APPLICATION"--' Electrical alternators, for duplex systems, are available and - Variable level float switches are available for controlling single supplied with an alarm. and three phase systems_ N iechanical alternators, for duplex systems, are available - Double piggyback variable level float switches are available with or without alarm switches- for variable level long cycle controls. 5>=LECTIOtd GUIDE Standard all models - Weight 38 lbs_ -'/Z H.1'. . 2 pole 81~- switch. no required. 1 2. Swgie pfjqyback variable fetal foot switch or d*ttbW pxjgyback variable levei. so Serbs convol Soiecfiort Dom switch- Refer to FUM77. Model vslls-Ph Mode Amps sbaplex WWI" a 6 nical attenmW 10-0072 or 10.0075. 10196 115 1 Auto 9.4 1 or l &T - 4. See Fh WIZ for corned model of Elec6tcal Alternator. N98 115 1 Non 9.4 2 2 3 or 4 & 5 S. Cord switch 10-0225 used as a s adivellm. speaTy duplex (3) or (4) ow 230 1 Ate 4.7 1 w 1 & 7 - Raea 6. Fos (4) hole 14 ak pinction bar, tat watertight connection or caked-in E98 230 1 Non 4.7 2 or2 & 6 3 or4 & 3 shrlpltac or dtiplex operatiotx 10.0002- 7. Two (2) hole J-Pak, for watertight connection or splice. CAUTION! :or information on addifionsl Zoeller products refer b 9 on Piggybadt Va9able Level Sieilcl es. All installation of controls. protection devices and :Tiring should be done by a qualifiad 77. x. Al :SumqkSewageBa*e,FWW. licensed electrician. All electrical and safety codes should be followed including the most 9noPhaseSimplatPum;t Conboi. FM15KAIanrl*dNW ROM recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). REST: WERE E855`.: For unusual condition a reserve safety factor is engineered into the design of every Zoeller pump. MOJL Tat P.O. SOK law? JAiiimft KY. ~ a.. I otrr~ KY 4M1-fell zzw S,,~ Aw- S.orw.zasiler., rTT4J INfp~4 v • ` Plot Plan Page '?of t? Property Owner L ~,j Faikt beW_s -Tve- I"=40ff. Legal Description c ~t 50,ru/lkuux-r, L, ARM (except where noted T' m "e }fRr &P 1-Rc Nv,A ©F- rhF- 5EA see • zz-, - o = Backhoe pit i UA), R Kj of i©w,J dF 't7Z~e ~ er. C*Dlx Cy W t i, DS f1 WAY North rte. 15' Afmalf PAL Z Sy r p Al- S P~ sT4,7 Q N - ' ,y4 _ - - - o 4 TOP o ~t ~71s ti q.7~ Sri Pt- n w vo C/i OT s''D Site Location: 3 AINe.: Oct-19-2010 01:59 PM St. Crcix County Plan/Zon ng 715-386-4686 1i 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer f3,, ,IL 1 Mailing Address 94 `Z c/ l 191 17\ Property Addresl 0 4 f t a / ~ W n (Verification required Cram Planning & Zoning Dep ont for now ons tiun.) City/State P~ t ~y l` 1 Parcel Identification Number P/ D - 00 - 0 3'a LEGAL D>ESMPTION 17Tt5 Propeily Location YV 14/ 14 , Set:. ova , T 29 N R_L~_W, Town of !-0_ Subdivision Plat: wiLA'd l~dz Lot #S19 Certified Survey Map # , Volume Page # , Warmnty Deed # (before 2007)Volume., Page # Spec house • yes no Lot lines identiflablo - yes : no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the fanetion of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities arc specified in §Cotunt. 83.52(1) and In Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition ontd/or (3) after inspection and pumping (if necessury). the septic tnnk is less than 1!3 flull of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sot forth, herein, as set by the Department of Commence and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three yearexpiration date. l/we certify that all statements on this form a true to the best of mytour knowledge. 11we am/are the owner(s) of the property described above, by vi warranty d recorded in Register of Deeds Office, Number of bedrooms IGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department, Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified, survey map if reference is made in the warranty deed, (REV. 08/05) . -0-" 15 w z I I 1 IS 7 C4 cqltq in 0 T n 4000 pop* ro t ,.WO" ~ ~ ~ 8 1 1 3.5'.3 7 Tx : 40.9(}409 . STATE BAR OF WISCONSIN FORM 3 - 2000 969281 Documcnt Number QUITCLAIM DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and C & J ST. CROIX CO,, WI Builders, Inc., Grantee. 12/11/2012 3:35 PM Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: NA Croi unty, State of Wisconsin (the "Property"): REC FEE: 30.00 Lot 0 nd 57 of Walnut Hill Farm, Town of Troy, St. Croix County, TRANS FEE: 140.40 Wisc in. PAGES: 1 Lots sold `as is' with all faults. Recording Area Name and Return Address: David J. Estreen 304 Locust Street Hudson, WI 54016 Vv Together with all appurtenant rights, title and interests. 040-1303-00-050;040-1303-00-057 Parcel Identification Number (PIN) This is not homestead property. Dated this 5th day of December, 2012. Citizens Stat J,~ . 4iA * Gene H b rman, Vice Chairman * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this 5th day of December, 2012 Personally came before me this 5th day of December, 2012 the above named Citizens State Bank by Gene * Haberman, Vice Chairman to me known to be the person(s) TITLE: MEMBER STATE BAR OF WISCONSIN who executed the foregoing instrument and acknowledged the (If not, same. authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAIFTED BY *Ja P P field aly~P lic, S f Wisconsin !WL co fission is permanent. (If not, state expiration date: Michael H Forecki Attorney ri', . y ) (Signatures may be authenticated or acknowledged. Both are not iVece sa ~8 'Names of persons signing in any capacity must be typed or printed b~ ow t 01 1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 TOOl~ l3 ~E ~ STEDT- Proper(yowner Parcel ID # L o 7- Sa z 3 F3-1 t Groundsurfaceelev. fl. Depth to MOW factor ku. 5ail Raf Ukdzon e Depth rD7 * Mt Color Redox Desorption Texhme Shudu re Consistence Boundary Roots GPOR in. unsell Qu. 5z. Cont. Cdor Gr_ Sz. Sh. -Etf#1 law 7 0. 5 L. Z fsh)t S tit CS 3 • -S - Z 5' ~6V L 2fS c i . S Y/e if/ j 5 o i L 2'F s b nNt. 0.5 . S 0,1 11,Afl -)4 y i Q Pit Ground surface ele, ft. Depth to Wniting factor Sol Race HOr17M Depth lL Dorton Red" Desaiplion Textwe StrUCbXe Consistence Boundary Roots GPM Mu nsell OL Sz. Cent Color Gr: S7- Sh. f ' 8oritg ~ Pit Ground stxface elev. ft. D E4M to factor Sod Appkabon Rate Fiortzan Depth Dominant Redox Dew "w- Texture Sp6dwe Conststence BotNAwy Roots G in. Munseft t2u. Sr- Cont Color . Sz Sh. 'Eff#f 'Eff#2 ' s t__t P"u! Ground surfaceelev. ft. I?eptlt to factor in. F-1 r~--##n9 Rate Horizon Depth n"ntrtant Redox Texture Sbuch" Consistence Boundary Roofs d3peff in. Munseft CKL Sz cow Gr. Sz. Sh. -Elfitf 'Efi#2 e Eftkwd #t = BOD, > 30 < 120 mg& acrd TSS >30 < f 60 atglt. ° Effluent #2 =1 OQ, < 30 mg/L and TSS < 30 mg(L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-9777. S8"330(RAW) Vllrsconsin Department of Commerce SOIL EVALUATION REPORT Page or 3 I)ivLsion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST: Gil.' 01)(-- Attach complete •V include, but not rn EROSION CONTROL PLAN must be Parcel I.D. 1- 07 I'.) percelld slope. sal completed before sanitary permit issuance by P D~ Date ie~ L PeraoW Womubon you provide may be used for secondary purposes (Privacy law. s.15.04 (1) (m)). Property Owner TODD Property Locah a TOPp'3ER5 Te7fl GovL Lot Dilq 5 1/4 S L T B N R l / E (or) W Properly Owner's MaikV Address Lot # Block # Subd. Name WSW (P 0 i 5 CA Wi LL Ave IVAN r Ki fA R t City SAJIWR State Zip Code -Phone Number ❑ City ❑ Village R Town Nearest Road ~r~2ov~ ~f7% MN 5So7(o ( &Sl) ay8• to9~ TRoy so. (3rfOUER ~C New Construction Use: (A' Residential / Number of bedrooms Code derived design flow rate 0 ~ Oa GPD ❑ Replacement ❑ Public or oornmercial -Describe: - t1 Parent material /DE s S O ~l to _ DoLo,N.•><-r Flood Plain elevation if applicable - N/ fL General comments and recd wriendations: SA ' N Bofft ❑ .2 o # Bodrv i8 ® Pit Ground surface elev. R Depth to kniting factor in. Sol Appkadon Rate Horizon Depth Dominant Color Red= Description Texture Structure Consistence Boundary Roots GPQff b in. Munsell Qu. Sz. Court. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 0-(* lo k z L afshr, dJ o 3 f . s • s~ N Z 6• o L zfSl c / f . s %A 3 q • 15 io L zf,S hK- ets lit 6 S - - S CLS I A n 1 # ® Pitt Ground surface elev. ft. Depth to uniting factor in. " Soft Application Rate Horizon Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPD/fl? 1~. In. Mu nseu Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 '011#2 I d /o t L fshK ks cs s N C / . S N 2- 17- It a t z, Zf-S hK, . S . o ~iL S ~wf t.5 oyo o Effluent #1 = BOD > 30 < 220 rrok and TSS >-W < 150 mg& ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg►L CST Name (Please Print) • -u j$ iz i c i`r Solature :X-2- ~.N~ er Address Uibricht & Associates Date Evaluation Conducted Telephone Number Private 715- 77A • 3 yy 2- 2812 1 Oth Ave. Spring Valley, WI 54767 l p~ PINS 4AORO x . 2 yo..._..'~ dtes oy~j " /OAS ' •SD ' ~ p yv . /p ~(D . /D • OaD • zd • oar dyo • log( , 0y0 •/00?6- ~D•~ oyo•/o*6-70• oyo . ,o~~ ago - oaa h1111 /~O/y TOT T31 ~ ~ S 7~EDT- pmperty c"M L o 7- S'~ Z 3 Parcel ID # page of { Boring '{s 13 P- . 3 t C round surface elev. Depth to limttirtg factor 5 l tTepth Dominant. Cwt Soil Mu icatiort Rate edox Description Texture Sir ictura Consistence Boundary RODW GPt ln, nseli Qu. 5z. Cont. Cwior Gr_ Sz. 5h. "Etf#1 'Etf#2 7 0. 5 io vji2 fshlc Ws -A Z 5• /oY L Z~S S c. S 1 S o iL 2--F sh ANt.~F2 a.S . S _ G • fay,-e- / ..Af •7< j Z3 Boxing # Boling Pit Ground surface elev. R. Depth to fimitirrg factor in liatzon Soil 822"on Rate Deptft Dominant Cc+twr f3edvx Description Texture Structure CcxrsisferrGe Boundary Roots taP'[1/lt? - i4furrsell Qu. Sa. Cant Color Sz. Sh. 'Eff# t '1rf##2 Borfrtg # tQ- Boling t l pit Ground surface elev. ft. Depth to H iting factor in. Sol Rate f fwtzon Depitt Dominant Color Redox Description. Textum S e Consistence Boundary (toots t4Pi? in. Munseii Qu. Sz. Cont Color f. Sz: Sh. 'EM#1 'Eff#2 Sad Boring pit Ground surface elev. ft. Depth to limiting factor in. gplicallm Rate Sol Horizon Depth Dorrtlnant color Redox c ription_ Texture Structure Consistence Boundary Roots 43PORe In. Munsefl Qu. Sz. Oont. Color Gr. Sz. Sh. 'Etf#l 'Eff#2 6 ' Effluent #t = BODt > 30 < X20 m91L and TSS >30,c 150 mgli. ` Effluent #2 = B005:< 30 tmg1L and TSS < 30 mgt. The Department of Commerce is an equal opportunity service provider and employer. If you creed assistance to access services or need material in an alternate forinat, please contact the department at 608266-3151 or TTY 608-264-8777. Keoezm ~smo? r PLOT PLAN WALNUT HILLS FARM. LOT # O Pg. 3 of 3 Contour elevation lines. • = Backhoe Soil pits. O = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. a uN05 w SCALE: 1 - FI y ~o ~ 133 1G .YS 2,q 132- 1 41- QH 0,O J6 1dv'40 Sys ~ . ~7. 7 S 3 sU s5 5 ~JOv,~v s yS 7- o,o ~,vid2L Z, S4,tJv 2~ ,